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5HTP for OCD

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Hi Wilma, if you will look in our Files section at the OCD and Inositol article,

there's a paragraph in it about 5HTP.

We did try it, along with many other things, for . No luck for us with

OCD, but doesn't mean it won't work for someone else. Inositol helped

in middle school but didn't help a bit when we tried it again later in high

school. I know some here in the group over the years were using it with a

combinatin of other things. So - never know until you try. Just read up on it

a lot, of course, before you try it. Especially if she is on any prescription

medication! Since you buy it yourself I don't think psychiatrists will suggest

it. Just talk to them about it if she is on another med so they will know you

are planning to add it, etc.

>

> Has anyone ever tried this for OCD, and would a psychiatrist ever try

something like this, do you think?

>

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CHRIS , PLEASE SCROLL DOWN - I had difficulty with paste and copy --Article is

good and current. Thanks Dana

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New Horizons in OCD Research and the

Potential Importance of Glutamate:

Can We Develop Treatments That Work

Better and Faster?

By H. Bloch, MD, Vladimir Coric, MD,

and Pittenger, MD, Ph.D.

First-line treatments for obsessive compulsive disorder (OCD) – cognitive

behavior therapy, drug therapy with selective serotonin reuptake inhibitors

(SSRIs), or both – are quite effective for many patients. However,

approximately one third of patients do not experience a significant reduction in

symptoms from these treatments, or from established second-line interventions.

Even in patients who do respond, symptom reduction usually occurs only over the

course of two to three months, and response is often not complete. The

development of treatments that work better and faster is a major goal of ongoing

research.

Glutamate in OCD

Existing medications for OCD target two neurotransmitters (brain

chemicals): serotonin and dopamine. However, there has been substantial

interest over the last eight years in the potential involvement of another

neurotransmitter, glutamate, in OCD. Glutamate is the most abundant excitatory

neurotransmitter in the brain; it is critical to the communication of nerve

cells with one another in practically every circuit in the nervous system. An

abnormally high level of glutamate can lead to neuron damage, and

glutamate-modulating therapies (medications aimed at affecting or normalizing

the actions of glutamate in the brain) have been explored in medical conditions

such as “Lou Gehrig’s Disease†(ALS) and in stroke.

Evidence from several sources suggests that abnormal levels of glutamate

may contribute to OCD. Investigators at the Ruhr University in Germany examined

the cerebrospinal fluid (CSF) of patients with OCD who were not on any

medication. They found that individuals with OCD had higher levels of glutamate

in the CSF than psychiatrically healthy controls. Since the CSF bathes the

brain, this suggests that the brain is exposed to high levels of glutamate in

patients with OCD. A similar increase of glutamate in the brain has been seen

using another technique, magnetic resonance spectroscopy (MRS), by investigators

at Wayne State University, and elsewhere.

The presence of abnormally high levels of glutamate in the brains of

individuals with OCD does not prove that it contributes to the disease –

problems with glutamate could be a consequence of the illness, rather than a

cause. However, recent genetic findings lend support to the idea that glutamate

imbalance may be an important causal factor in at least some cases of OCD. Two

independent groups, from the University of Toronto and the University of

Chicago, published evidence in 2006 that a protein that carries glutamate in the

brain is linked to OCD in some cases; more recent studies from groups at the

Massachusetts General Hospital and s Hopkins University have found the same

thing. Although it is not yet clear whether these genetic linkages correspond

to a functional problem with this protein, problems with these glutamate

transporters can increase the amount of glutamate found outside neurons, which

might explain the increased glutamate seen in the brain, and possibly lead to

OCD symptoms.

Recent findings in mice further support the idea that changes in glutamate

in the brain can produce behaviors that resemble OCD. Researchers at Duke

University have described a mouse that is anxious and grooms itself

compulsively. They genetically altered the mouse, so that it is missing the

SAPAP3 gene. The SAPAP3 gene is a critical piece in structure of the glutamate

receptor. The anxiety and compulsive grooming behavior of these mice decreased

when they were given an OCD medication – a selective serotonin reuptake

inhibitor (SSRI). A few doses of an SSRI did not decrease compulsive symptoms;

the medication has to be given over a long period of time to have an affect –

the same pattern seen with patients taking SSRIs to treat their OCD.

Although it remains unclear whether this gene (SAPAP3) is involved in OCD,

the one genetic study performed to date in humans with OCD, from researchers at

Duke and s Hopkins, showed preliminary evidence of a relationship to

grooming disorders such as Trichotillomania but no links to OCD. Regardless,

further work in this and related animal models will increase our understanding

of how changes in the brain glutamate, and how neurons respond to it, can lead

to compulsive behavior patterns.

Glutamate-targeting Medications

Is it possible then that medications that affect glutamate in the brain

will benefit patients whose OCD does not respond to existing therapies? This

hope has guided research in our clinic over the past several years, and early

results, from our group and elsewhere, are promising – although the evidence

for such drugs is not yet conclusive.

Fortunately, a number of medications that affect glutamate levels are

already FDA approved for other medical conditions and are therefore readily

available for research and clinical use. One such medication is riluzole

(Rilutek®), which has been marketed since 1996 for Lou Gehrig’s disease

(ALS). Riluzole affects glutamate levels in several ways. In an initial

open-label study in 2005 and a case series in 2008, we found that approximately

half of the severely ill, treatment-refractory patients who have not responded

to other treatments improved significantly when riluzole was added to their

SSRI. Researchers at the National Institute of Mental Health have found similar

results using riluzole in children with OCD. Controlled, double-blind studies

(the best way to test the effectiveness of a medication) for riluzole in adult

and pediatric OCD have already begun.

A second drug that is already available and affects how neurons respond to

glutamate is memantine (Namenda®). Several case reports and two recent

open-label case series suggest that the addition of memantine to standard

medication therapy can benefit both children and adults with OCD. As in the

case of riluzole, these studies are uncontrolled and need to be replicated in

larger, placebo-controlled studies.

There is also some limited evidence suggesting that a third medication -

N-acetylcysteine or NAC - also has benefit in the treatment of OCD. NAC is

available without a prescription. It is an antioxidant and is used in cases of

acetaminophen (Tylenol®) overdose to protect the liver from damage. However,

animal studies by researchers at the Medical University of South Carolina have

found that NAC can affect levels of brain glutamate as well. We worked with a

patient with OCD who improved significantly after we added NAC to her existing

medications. Unpublished clinical experience, from our group and elsewhere,

further suggests that the agent may be of benefit in at least some patients with

OCD. Well-controlled studies have shown benefit from NAC in a variety of other

disorders of compulsive and impulsive behaviors including pathological gambling,

Trichotillomania, and drug craving. Because it is inexpensive, has no

significant side effects, and is available over-the-counter, this drug is a

potentially attractive therapeutic option, though the evidence for benefit in

OCD remains extremely thin.

Glutamate in Depression and the Possibility of a Rapidly-acting Anti-obsessional

Drug

Abnormal glutamate levels may also play an important role in major

depressive disorder. All of the medications discussed above (riluzole,

memantine, and N-acetylcysteine) have been investigated in depression by

researchers at Yale, the National Institutes of Health, and elsewhere. Indeed,

an important question for future research is how the glutamate problems in these

two disorders, which often occur together, differ from one another.

Glutamate is a neurotransmitter – a chemical that communicates from one

nerve cell to another. A neuron can respond to glutamate when it binds to a

specific kind of protein, a receptor (a receiver of a brain chemical message,

like your cell phone receiving a phone call). So alterations in glutamate

affect nerve cells by changing the activation of these receptors, and targeting

the receptors with medications can change how the neurons respond to glutamate.

There are several receptors for glutamate; a particularly important one is

called the NMDA receptor. Drugs that affect these NMDA receptors have recently

been found to produce a remarkably rapid antidepressant response. This

contrasts starkly with the delayed response typically seen with SSRIs in both

depression and OCD. This observation was first made by researchers at Yale, who

reported in 1998 that depressed patients receiving a single dose of the

NMDA-targeting drug ketamine became rapidly better, and stayed better for up to

a week. Ketamine can produce a short “high,†lasting 1 or 2 hours.

However, the improvements of mood were greatest at 24 hours and lasted in some

subjects for as long as seven days, making it clear that they were not just a

result of this high. This striking and unexpected effect was reproduced in a

double-blind study at the National Institutes of Health in 2006.

Memantine also affects NMDA receptors, but its effect is much weaker than

that of ketamine. Unfortunately, a controlled study of memantine in depression

from the National Institute of Mental Health did not show benefit. Newer

medications that act on this NMDA receptor are under development.

Ketamine is by no means the answer for major depression. The

antidepressant effects of ketamine usually wear off by a week or two.

Furthermore, ketamine’s addictive and abuse potential and the fact that it

needs to be administered intravenously limit its long-term use. Potentially

unpleasant psychological symptoms, such as anxiety, sadness, disorientation,

flashbacks, and hallucinations can sometimes emerge during ketamine

administration and also limit its potential for widespread use. However, a

limited trial of ketamine may be useful to help a patient break out of a

particularly severe or treatment-refractory depression. In addition, the rapid

antidepressant effect of ketamine opens a window into an entirely new way of

thinking about how to treat depression. A better understanding of how this drug

works in the brain could lead to the development of new drugs that do not have

ketamine’s drawbacks, but do have its advantages - in particular, a more rapid

effect than any standard antidepressants.

These observations raise exciting new possibilities for the field of OCD

research. If glutamate contributes to both depression and OCD, and if ketamine

can produce a rapid antidepressant effect, would this medication, or similar

drugs that affect glutamate or the NMDA glutamate receptor, also be effective

treatments for OCD? Depression frequently occurs along with OCD – could drugs

that affect the NMDA receptor, like ketamine, be of benefit to both? Most

excitingly, the antidepressant effects of ketamine are remarkably rapid – much

more so than traditional medication or psychotherapy. It has long been possible

to rapidly treat severe depression using ECT; but ECT is not effective in the

treatment of OCD, and no rapid treatments have been available. Perhaps this

unfortunate limitation will change.

In sum, increasing evidence indicates that abnormal levels of the

neurotransmitter glutamate contribute to OCD and may be a fruitful target for

new therapies. Ketamine’s unexpected, rapid antidepressant effect suggests

that similar anti-obsessional effects are a real possibility, since the

disorders frequently occur together and problems with glutamate appear to be

associated with both. No investigations of ketamine in OCD have been published

to date, but developing new clinical treatments like this based on our advancing

understanding of OCD at the molecular, cellular, and systems level has the

potential to usher in a new era of therapeutics that work better and faster than

those we have today.

Bloch, MD, is a Fellow in the Solnit Integrated Program in Child and

Adult Psychiatry at Yale University and the Assistant Director of the Yale OCD

Research Clinic. Vladimir Coric, MD, is a Senior Research Scientist and Past

Director of the Yale OCD Research Clinic. He is also an Associate Clinical

Professor of Psychiatry at Yale University and a member of the OCF Scientific

Advisory Board. Pittenger, MD, Ph.D., is an Assistant Professor of

Psychiatry and Director of the Yale OCD Research Clinic. He is also an

Attending Psychiatrist at the Connecticut Mental Health Center and an Associate

at Yale-New Haven Hospital.

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International OCD Foundation PO Box 961029, Boston, MA 02196

Dana -Kennedy

Re: 5HTP for OCD

Hi Dana, thank you! OK - I don't see the article??

> >

> > Has anyone ever tried this for OCD, and would a psychiatrist ever try

something like this, do you think?

> >

>

>

>

>

>

>

>

>

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>

> Has anyone ever tried this for OCD, and would a psychiatrist ever try

something like this, do you think?

>

Hi Wilma,

I tried using 5HTP for my daughter, but it didn't seem to do any good. I

eventually had to try medication because her symptoms were so severe. One

psychiatrist I spoke with did not support me using 5HTP to help my daughter, but

I tried it anyway. Maybe I didn't give the 5HTP enough time to work. Good

luck.

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Thanks Dana! That's really interesting! I know other " brain chemicals " are

involved with OCD, like to read that they may have figured out how (it is too

high, low...) with particular ones. May try that NAC on this summer,

will have to research it a bit. I think at least one person here has mentioned

using/trying it before....

Again, thanks for sharing, good info!

>

>

>

> CHRIS , PLEASE SCROLL DOWN - I had difficulty with paste and copy --Article is

good and current. Thanks Dana

>

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  • 4 weeks later...
Guest guest

My 16-year old daughter takes 5HTP and L-Tyrosine, in addition to pharmaceutical

meds, for OCD, anxiety and depression. It seems to help a bit.

Steph in Virginia

>

> has 5htp worked for anyones ocd? if so...how much did u start with? thanks

>

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